Leptospirosis

Leptospirosis Presented by: Pauline Teo Siew Chin 13th May, 2009

OUTLINE Introduction  Leptospira interrogans  Transmission  Clinical features  Diagnosis  Management  Prevention  Conclusion 

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Leptospirosis A zoonotic disease  Caused by Leptospira interrogans  Geographically widespread  Most common in tropical and subtropical areas with high rainfall  First detected in 1886 by Adolph Weil  Synonyms: Rat fever, fish handler's disease, mouse fever & rice field fever 

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Leptospira interrogans Flexible, filamentous bacteria made up of fine spirals with hook-shaped ends  Gram -ve  Spirochetes  > 200 known serotypes  Obligate aerobes  Slow growing in culture  Survives in a moist environment for weeks-months 

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Transmission  

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Wild & domesticated animal hosts  Human Common reservoirs: rodents, dogs & farm animals Human: incidental, “dead-end” hosts Contact with soil, water & feed contaminated by urine or tissue of infected animals  Occupational exposure  Recreational activities Enter through broken skin or mucous membranes or conjunctiva 5

Adapted from http://www.pasteur.fr/

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Clinical Features Incubation period: 2 - 30 days  Clinical presentations range from a selflimited febrile illness to a severe illness associated with multi-organ damage  Mortality rate in severe cases: 10-15% 

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Clinical Progression of Anicteric & Icteric Leptospirosis Anicteric Leptospirosis

Icteric Leptospirosis ( Weil’s Syndrome)

(pigmented part of eye)

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Clinical Features (con’t)

petechial rash

conjunctival suffusion

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Diagnosis

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Management 1. 

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General Close temperature, BP, PR & RR monitoring, I/O chart Adequate hydration, keep temp <38oC

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Management (con’t)

2. Antibiotics  

Most effective if initiated within 1 week of disease onset Mild:  treated as out-patient  given oral antibiotics Drugs

Adult Dose

Children Dose

Doxycycline

100mg bd

2 mg/kg/day in 2 equally divided doses

Amoxycillin

1g qid

10 – 25 mg/kg tds

Ampicillin

1g qid

10 – 25mg/kg qid

Erythromycin

250 - 500 mg qid

10 - 25 mg/kg qid 12

Management (con’t) 2. Antibiotics (con’t)  Severe:  intravenous antibiotics

Drugs

Adult Dose

Benzylpenicillin 1.5mU qid (Penicillin G)

Children Dose 250,000-400,000 units/kg/day in 4-6 divided doses

Ampicillin

500 mg – 1 g qid

10 – 25 mg/kg qid

Amoxycillin

500 mg – 1 g tds

10 – 25 mg/kg tds

Ceftriaxone

1 g od

80-100 mg/kg OD

Cefotaxime

1 g qid

150-200 mg/kg/day in 3-4 equally divided doses

Duration: 1 week  A Jarisch-Herxheimer reaction triggered by penicillin Erythromycin 250mg qid can occasionally 20be - 50 mg/kg/day in 3therapy - 4 divided 

doses

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Management (con’t) 3. Supportive  ICU care in severe cases  Fluid & electrolyte therapy  Dialysis support for renal failure  Ventilatory support for respiratory failure

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Prevention Vaccination of domestic mammals  Avoid contact with potentially infected animals and contaminated water & soil  Protective clothing, boots & gloves  Effective rat control  Antimicrobial prevention  doxycycline 200mg/week 

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Conclusion 

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Leptospirosis or rat fever is caused by Leptospira interrogans which is found in rodents, dogs, farm animals & wild mammals Transmit through exposure to infected urine or contaminated water, soil or mud Various antibacterial medications are useful in treatment of leptospirosis

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REFERENCES Aberg JA, Goldman MP, Gray LD & Long JK 2006. Infectious Disease Handbook (6th edition). Lexi-Comp, Inc Antony SJ. Leptospirosis- An emerging pathogen in travel medicine: A review of its clinical mainifestations and management. J Travel Med 1996;3:113-118 Howell D & Cole D. Leptospirosis: A waterborne zoonotic disease of global importance. Georgia Epidermiology Report August 2006;22(08) Khairani-Bejo S, Norhamizah AR, Bahaman AR & Kadir AA 2006. Determination of susceptibility of Malaysian Leptospira isolate to antimicrobial agents. Journal of Animal and Veterinary 2006;5(2):111-113 MacAllister C. Leptospirosis. Oklahoma Cooperative Extension Service. McBride AJA, Athanazio DA, Reis MG & Ko Al 2005. Leptospirosis. Current Opinion in Infectious Diseases 2005;18:376-386 Pappas G & Cascio A. Optimal treatment of leptospirosis: queries and projections. International Journal of Antimicrobial Agents 2006;28:491-496 Saunders J 1979. Clinical features and management of leptospirosis in Malaysia. Malaysian J Pathol 1979;2:7-9 Soo HH, Lau LG & Chew PH 2005. Sarawak Handbook of Medical Emergencies (2nd edition). C.E. Publishing 2007 UpToDate® Database 17

THANK YOU!

13th May, 2009